Three major Ontario healthcare unions have endorsed the recommended expansion of the scope of practice for Registered Practical Nurses. There are approximately 60,000 Registered Practical Nurses in Ontario.
TORONTO — The changes recommended by the College of Nurses of Ontario would allow an RPN to perform the following activities without an order, outside of public hospitals:
- Irrigating, probing, debriding and packing of a wound below the dermis or below a mucous membrane
- Venipuncture in order to establish peripheral intravenous access and maintain patency, in certain circumstances
- Putting an instrument, hand or finger beyond the individual’s labia majora for the purpose of assessing or assisting with health management activities
- Putting an instrument or finger beyond an artificial opening into the client’s body for the purpose of assessing or assisting with health management activities
RPNs with relevant competence can currently perform these activities if they have an order.According to the College of Nurses, “Initiation is the process of independently deciding that the procedure is required, then performing that procedure without an order. While nurses may have access to perform controlled acts, they may not be able to do so in certain practice settings because of legislation or facility policies. For example, RNs and RPNs who practice in hospitals will always need an order. This is a requirement under the Public Hospitals Act, 1990. To learn more about initiation, read the Authorizing Mechanisms practice guideline.
“Our vision is to have a province of nurses who work toward creating workplaces where nurses are free of professional discrimination and are fully utilized and valued for their knowledge, skill, judgement and vital contribution to Ontario’s healthcare system. We are committed to being evidence-informed and data driven – initiatives cannot be based on superficial, surface level understandings of the issues. When organizations support the expansion of scope for the NP and RN but are against the RPN expanded scope, it demonstrates a disregard of the practical implications for the healthcare system and a lack of respect for the contributions of our RPNs across the province.”
SEIU Healthcare Nursing Division President Jackie Walker.
“All nurses have a high level of skill and education. Registered Practical Nurses are capable of independently initiating the controlled acts as recommended by the College of Nurses of Ontario. The College of Nurses consulted widely on expanding the RPN’s scope of practice, reviewing entry requirements, practice standards, enforcement requirements and its Quality Assurance Program to enable nurses to practice safely and competently within the new proposed RPN scope. The remedy to the shortage of nurses in the province is to ensure that everyone is working to the full extent of their capacity.”
Judy Bain, OCHU-CUPE Vice-president and Chair of CUPE’s RPN Committee.
“All classes of nurses fundamentally understand that to perform any nursing functions, they must have the foundational knowledge and experience to carry out any of the regulated acts,” said Katha Fortier, registered practical nurse and Assistant to the Unifor National President. “Nurses face these decisions every single day, and they are trained to understand when something falls outside of their capability and seek guidance or assistance as needed. A nurse cannot be an expert in everything, nor are they expected to be.”
Katha Fortier, Assistant to the National President, Unifor.